Behind Alzheimer's disease, vascular dementia is the second most common form of dementia in Western countries comprising nearly 6%-32% of all patients seen in therapy. Vascular dementia is most often seen in individuals over 60 years of age and is the result of several small brain infarcts.
Objectives
The objectives of this page are to:
Learn more about vascular dementia.
Learn about common symptoms associated with vascular dementia.
Learn about common risk factors associated with vascular dementia.
Learn about how vascular dementia is diagnosed.
Learn valid outcome measures to use in the assessment of a patient with dementia.
Learn about areas of treatment and prevention for vascular dementia.
Learn about how to help patients and caregivers manage the symptoms of vascular dementia.
What is Vascular Dementia?
Vascular dementia is primarily associated with impairments in memory and cognition due to a block or reduction of blood flow to the brain which causes infarcts to occur. Vascular dementia is unique in that it is represented by an abrupt onset while levels of function can decline and improve periodically. In contrast, Alzheimer's disease involves a slow and gradual deterioration in function. However, it is common for vascular dementia to coexist with Alzheimer’s disease and Lewy body dementia.
Symptoms of vascular dementia are similar to post-stroke symptoms and include confusion, disorientation, difficulty speaking and walking, headache, and numbness on one side of the body. If small blood vessels are blocked, symptoms may include impaired planning and judgment, uncontrolled laughing or crying, inability to pay attention, difficulty in social situations and with word finding.
Many different subtypes of vascular dementia have been identified including multi-infarct dementia involving cortical and/or subcortical areas, localized infarcts, small vessel disease, hemorrhagic lesions involving subdural hematomas or intraparenchymal hemorrhages, and hypoperfusion.
Risk factors for vascular dementia include:
Hypertension
Arrhythmia's (atrial fibrillation)
Myocardial infarct
TIA's
Diabetes
Uncontrolled cholesterol or blood sugar
Obesity
Smoking
Alcohol consumption
How is Vascular Dementia diagnosed?
Currently, there is no well-defined and widely used criterion to accurately diagnose vascular dementia. However, Kirshner identified three commonly used criterions in an attempt to achieve this goal. Characteristics of the three diagnostic criterions are listed below.
1. National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Researche et l’Enseigment en Neurosciences (NINDS-AIREN)
Documented dementia
Decline in memory and two other cognitive domains
Impairment in ADL’s
Evidence of cerebrovascular disease by clinical history, clinical examination, or brain imaging
Gait abnormalities
Mood changes
Psychomotor slowing
Extrapyramidal signs
The dementia and cerebrovascular disease must be “reasonably related”
2. California Criteria for Ischemic Vascular Dementia
Dementia established by clinical examination
Progressive worsening of cognitive function
Evidence of ≥ 2 strokes by clinical neuroradiologic criteria
Evidence of ≥ 1 hemisphere infarct by CT or MRI
Diagnosis of definite ischemic vascular disease
3. Hachinski Ischemic Scoring System (total score ≥ 7 - considered to have vascular dementia, ≤ 4 - primary degenerative dementia)
Abrupt onset (2)
Stepwise deterioration (1)
Fluctuating course (2)
Nocturnal confusion (1)
Relative preservation of personality (1)
Depression (1)
Somatic complaint (1)
Emotional incontinence (1)
History of hypertension (1)
History of strokes (2)
Evidence of associated atherosclerosis (1)
Focal neurologic symptoms (2)
Focal neurologic signs (2)
Examination for Vascular Dementia
Dementia affects many aspects of daily life for both the patient and the caregiver. Sheehan has identified valid outcome measures to use on patients with dementia to capture how much the disease has affected their overall quality of life.
1. Cognition
Montreal Cognitive Assessment*
2. Function
Bristol Activities of Daily Living Scale (BADLS)
Barthel Index
The Functional Independence Measure
Instrumental Activities of Daily Living scale
The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)
3. Behavior
Neuropsychiatric Inventory
Cohen-Mansfield Agitation Inventory
BEHAVE-AD
4. Quality of Life
Generic measures of quality of life (EuroQol)
Short Form -36
The Alzheimer’s Disease-related Quality of Life scale (QoL-AD)
DEMQOL
5. Depression
Geriatric Depression Scale (GDS)
Cornell scale for Depression in Dementia
The Montgomery Asberg Depression Rating Scale (MADRS)
Hamilton Depression Rating Scale
Hospital Anxiety and Depression Scale
6. Caregiver Burden
General Health Questionnaire
Zarit Burden Interview
7. Overall dementia severity
Clinical Dementia Rating Scale
Global Deterioration Scale
Clinicians Global Impression of Change (CIBIC-Plus)
* Sheehan identifies this test as particularly useful for patients with vascular dementia
Treatment for Vascular Dementia
The best treatment for vascular dementia is the prevention and proper management of cardiovascular risk factors. From population studies it has been found that individuals with cognitive deficits had an elevated systolic blood pressure for 10 years before the onset of their deficits and impairments. Therefore, controlling systolic blood pressure through medication, exercise, and diet is a key component to preventing and managing vascular dementia.
Currently, there is no specific drug that has been approved by the U.S. Food and Drug Administration (FDA) to treat vascular dementia. However, cholinesterase inhibitors may be prescribed to increase chemical messengers to help with memory and judgment. Memantine may also be prescribed to enhance chemical messengers which perform information processing and retrieval.
Exercise for persons with dementia should focus on decreasing depression, falls, and cardiovascular risk factors while addressing their personal goals. Evidence for exercise prescription for persons with cognitive impairment has been successful in improving functional activities when the following components are addressed:
Aerobic activities are performed at a moderate intensity for at least 30 minutes, 5 days per week
Exercises to maintain or improve balance
Strength training of moderate to high intensity on 2 days of the week
Flexibility exercises
Managing Vascular Dementia Tips for patients:
Establish a day to day routine
Create lists to help with memory problems
Keep your brain sharp by completing puzzles and crossword puzzles.
Take your medication regularly – use an organized pill box to help you take the right dosage at the right time
Attend a support group
Get regular physical activity!
Tips for caregivers:
Take care of yourself by eating healthy meals and exercising
Connect with support groups by contacting your local Alzheimer’s Association
Lopez OL, M.D., Kuller LH, M.D., Becker JT, PhD. Diagnosis, risk factors, and treatment of vascular dementia. Current Neurology and Neuroscience Reports. 2004; 4(5):358-67. http://search.proquest.com /docview/879657989?accountid=15070.
Kirshner HS. Vascular dementia: A review of recent evidence for prevention and treatment. Current Neurology and Neuroscience Reports. 2009;9(6):437-42. http://search.proquest.com/docview/ 879662561?accountid=15070.
Behind Alzheimer's disease, vascular dementia is the second most common form of dementia in Western countries comprising nearly 6%-32% of all patients seen in therapy. Vascular dementia is most often seen in individuals over 60 years of age and is the result of several small brain infarcts.
Objectives
The objectives of this page are to:
What is Vascular Dementia?
Vascular dementia is primarily associated with impairments in memory and cognition due to a block or reduction of blood flow to the brain which causes infarcts to occur. Vascular dementia is unique in that it is represented by an abrupt onset while levels of function can decline and improve periodically. In contrast, Alzheimer's disease involves a slow and gradual deterioration in function. However, it is common for vascular dementia to coexist with Alzheimer’s disease and Lewy body dementia.
Symptoms of vascular dementia are similar to post-stroke symptoms and include confusion, disorientation, difficulty speaking and walking, headache, and numbness on one side of the body. If small blood vessels are blocked, symptoms may include impaired planning and judgment, uncontrolled laughing or crying, inability to pay attention, difficulty in social situations and with word finding.
Many different subtypes of vascular dementia have been identified including multi-infarct dementia involving cortical and/or subcortical areas, localized infarcts, small vessel disease, hemorrhagic lesions involving subdural hematomas or intraparenchymal hemorrhages, and hypoperfusion.
Risk factors for vascular dementia include:
How is Vascular Dementia diagnosed?
Currently, there is no well-defined and widely used criterion to accurately diagnose vascular dementia. However, Kirshner identified three commonly used criterions in an attempt to achieve this goal. Characteristics of the three diagnostic criterions are listed below.
1. National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Researche et l’Enseigment en Neurosciences (NINDS-AIREN)
2. California Criteria for Ischemic Vascular Dementia
3. Hachinski Ischemic Scoring System (total score ≥ 7 - considered to have vascular dementia, ≤ 4 - primary degenerative dementia)
Examination for Vascular Dementia
Dementia affects many aspects of daily life for both the patient and the caregiver. Sheehan has identified valid outcome measures to use on patients with dementia to capture how much the disease has affected their overall quality of life.
1. Cognition
- Montreal Cognitive Assessment*
2. Function- Bristol Activities of Daily Living Scale (BADLS)
- Barthel Index
- The Functional Independence Measure
- Instrumental Activities of Daily Living scale
- The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)
3. Behavior- Neuropsychiatric Inventory
- Cohen-Mansfield Agitation Inventory
- BEHAVE-AD
4. Quality of Life- Generic measures of quality of life (EuroQol)
- Short Form -36
- The Alzheimer’s Disease-related Quality of Life scale (QoL-AD)
- DEMQOL
5. Depression- Geriatric Depression Scale (GDS)
- Cornell scale for Depression in Dementia
- The Montgomery Asberg Depression Rating Scale (MADRS)
- Hamilton Depression Rating Scale
- Hospital Anxiety and Depression Scale
6. Caregiver Burden- General Health Questionnaire
- Zarit Burden Interview
7. Overall dementia severity* Sheehan identifies this test as particularly useful for patients with vascular dementia
Treatment for Vascular Dementia
The best treatment for vascular dementia is the prevention and proper management of cardiovascular risk factors. From population studies it has been found that individuals with cognitive deficits had an elevated systolic blood pressure for 10 years before the onset of their deficits and impairments. Therefore, controlling systolic blood pressure through medication, exercise, and diet is a key component to preventing and managing vascular dementia.
Currently, there is no specific drug that has been approved by the U.S. Food and Drug Administration (FDA) to treat vascular dementia. However, cholinesterase inhibitors may be prescribed to increase chemical messengers to help with memory and judgment. Memantine may also be prescribed to enhance chemical messengers which perform information processing and retrieval.
Exercise for persons with dementia should focus on decreasing depression, falls, and cardiovascular risk factors while addressing their personal goals. Evidence for exercise prescription for persons with cognitive impairment has been successful in improving functional activities when the following components are addressed:
Managing Vascular Dementia
Tips for patients:
- Establish a day to day routine
- Create lists to help with memory problems
- Keep your brain sharp by completing puzzles and crossword puzzles.
- Take your medication regularly – use an organized pill box to help you take the right dosage at the right time
- Attend a support group
- Get regular physical activity!
Tips for caregivers:Resources
References